Report

Expert Consultation to Review the Design of India Health Policy & Systems Research Fellowship Program 24th June 2020

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Strengthening health systems requires a system thinking lens & an acknowledgement of complexity in

bringing about people-centric transformational change. Approaches that integrate these are often lacking

due to limited capacity in public health research institutions and the community to apply a health systems

lens using state-of-the-art public health and social science research methods. Health Systems Transformation

Platform (HSTP) & Institute of Public Health (IPH), Bengaluru envisage a fellowship program to improve the

capacity for health policy and systems research (HPSR) in India. A team of researchers from both these

organizations consulted Indian and global HPSR experts to put together a draft fellowship program, structure,

and curriculum. In June 2020, thirty HPSR practitioners participated in the expert consultation to review the

program and provided their expert advice.

Experts reinforced the need for this fellowship in India. Discussion echoed the efforts required for nurturing

this program and for it to be framed according to the Indian context and local needs. Experts believe a

nonlinear approach to HPSR is beneficial. Considering multidisciplinary nature of HPSR, fellows selected

should represent diverse disciplines of public health & health systems research including professionals with

experience in policy interface & program implementation. Fellows should be oriented to complexities &

dynamic nature of the health systems, role of health systems stakeholders with focus on policymakers &

community, public health ethics, policy analysis framework & tools. Use of Indian illustrative examples/ case

studies, role play/ simulations, peer-to-peer learning were emphasised. Learnings from HPSR training courses

in LMICs show that a demand driven and participatory approach through involvement of governments and

other key stakeholders at state/ local level ensures sustainable development of HPSR discipline and advocate

an evidence-based approach to reform.

Based on inputs received from this consultation, the team will work with guidance from key HPSR experts to

revise the program. An action plan for process of redesign will be developed including the use of a conceptual

framework consisting of key program elements, content, and pedagogy. This analysis across multiple levels

of the proposed program (curriculum, content, mentorship, online teaching, and pedagogy) will be finalised

in the coming months.

HSTP and IPH will engage with stakeholders frequently and explore arrangements with governments, Indian

and global public health schools to collaborate on this initiative. This spirit of collaboration and knowledge

exchange is at the core of HSTP’s values.

Dr Maharaj Kishan Bhan, HSTP’s pillar of strength, continues to inspire our work. We are grateful to the

HSTP Board for their support & HPSR practitioners who provided expert guidance. Special thanks to the

efforts of both HSTP (Rajeev Sadanandan, N Devadasan, Rahul Reddy, Vivek Panwar) and IPH Bengaluru

(Upendra Bhojani, Prashanth NS, Dorothy Lall, Kranthi Vysyaraju, Sumegha Asthana, Harish H N, Pramod

Kumar, Praveen Rao, Mahesh Kadammanavar and Yogin Gowda). Thanks to the rapporteurs for their

succinct summary of the breakout sessions.

Executive Summary

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Health Policy & Systems Research (HPSR) is an emerging field that seeks to understand and improve how

societies organize themselves in achieving collective health goals, and how different actors interact in the

policy and implementation processes to contribute to policy outcomes. It is inter-disciplinary, a blend of

economics, sociology, anthropology, political science, public health and epidemiology that together draw a

comprehensive picture of how health systems respond and adapt to health policies, and how health policies

can shape − and be shaped by − health systems and the broader determinants of health. There is limited

capacity to use this research approach in India. Health Systems Transformation Platform (HSTP), in

collaboration with Institute of Public Health (IPH), Bengaluru is working towards launching the ‘India HPSR

Fellowships Program’ to meet this need. The India HPSR Fellowship program seeks to provide a high-quality

blended training program for mid-career Indian researchers and develop opportunities for continuous

learning, peer engagement & support transformational change in the HPSR ecosystem in India.

The fellowship program and curriculum are being designed by the HSTP - IPH Bengaluru team in consultation

with several HPSR experts based on their experience of health systems in India & other LMICs, at research

and policy levels as well as experience in teaching research methods.

An early draft of the theory of change (ToC) articulates how the course design, content and components are

expected to achieve the outcomes of the training. Mid-level career professionals (fellows) with an interest in

HPSR are selected and provided training to conduct HPSR. Fellows would be able to frame relevant HPSR

questions and prepare proposals to obtain a research grant and complete their research study. This blended

training along with active mentoring/ coaching support throughout the course enables fellows to learn by doing.

One of the key assumptions of the program involves bringing together experience of diverse disciplines, and

stakeholders to create a vibrant peer-to-peer learning. The goal is to develop HPSR practitioners who continue

to learn and foster dialogue with stakeholders creating the required HPSR ecosystem for healthy India. (details

in next page)

Source: Pratt et. al. (2020) Justice: a key consideration in health policy and systems research ethics. BMJ Global Health

Overview

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Theory of Change

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An expert consultation was conducted on 24 June 2020 (1.30 to 5.00 pm IST). The objective of the consultation

was to review the India HPSR Fellowship program design, structure, curriculum, and pedagogy. The participants

were Indian and global researchers & HPSR practitioners from leading universities and research institutions. In

addition, people active in raising the profile of HPSR globally including the WHO Alliance for Health Policy and

Systems Research, Health Systems Global and policymakers with experience of working with researchers and

practitioners also participated. Subsequent consultations will be widened to include a greater diversity of

professionals and organizations in government, academia, and civil society. A total of 61 participants attended

the consultation, including experts and invited observers. The proposed program design, structure, and

curriculum for the consultation was shared in advance to facilitate in-depth discussions during the consultation.

The three-and-a-half-hour expert consultation was structured as below: (See the Agenda)

1. After the opening remarks by representatives of HSTP and IPH Bengaluru, the context and overview of

the proposed fellowship program was presented.

2. A panel discussion was conducted with experts instrumental in building the field of HPSR and conducted

HPSR training programs in other settings. This session intended to learn from their experiences in HPSR

practice, identify gaps in the proposed curriculum and seek inputs for the overall direction of the

program. The session allowed for questions/ comments from the larger audience.

3. Four parallel theme-based sessions were organised to review proposed content: quantitative approaches

in HPSR, qualitative and social science research approaches, pedagogy, and policy & practice. Each

session was a group discussion with 4-5 experts in the field, a facilitator, and a rapporteur.

4. In the concluding session, rapporteurs summarized the discussions in theme-based sessions.

Objectives

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• Opening remarks by Mr Rajeev Sadanandan (CEO, HSTP) & Dr Upendra Bhojani (Director, IPH Bengaluru) emphasized stakeholder consultation is key to designing the program, understanding expectations, and learning from experiences elsewhere. Collaboration and dialogue are at the core of this work and the team is exploring partnerships with governments and all relevant institutions to strengthen this program.

• Overview of the fellowship was presented by Dr N Devadasan (Technical Advisor, HSTP), Dr Prashanth N Srinivas (Assistant Director, Research, IPH Bengaluru) & Dr Dorothy Lall (Assistant Director, Education, IPH Bengaluru). They introduced intent of the proposed program, its blended structure (involving online and face-to-face components along with mentoring through contact sessions), post-fellowship engagement to anchor a thriving HPSR ecosystem in India. The program is designed with a learner-centred pedagogy. Backward design was used to develop the content where learning outcomes were identified and these guided curriculum design process.

• The program aims to train 20 Indian mid-career researchers with relevant post-graduate qualification or comparable experience. The current expectation is that the candidates applying for the program shall have considerable experience and training in a discipline within public health research. The key drivers of the course design are given in the figure below.

• Focus is on a blended learning approach, beginning with online learning phase followed by face-to-face training and research grant phase with active mentoring support. The entire duration of the program is 15-18 months. An online learning platform will be used through all the three phases. Learning activities shall range from short recorded lecture videos to interactive activities for application of learned concepts. Implications of the program lie in creating a HPSR community of practice across multiple professionals, groups, and research institutions.

• Upon completion of training, HPSR fellows are expected to have the abilities to address complex health systems problems by framing policy-relevant and demand-driven research questions, appreciate multiple perspectives and disciplinary approaches to address the research question, synthesize and support evidence for policymaking, and assess the impact of implementation.

Proceedings

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Panellists:

• Abdul Ghaffar, Executive Director, WHO Alliance for HPSR (Switzerland),

• Barbara McPake, Director, Nossal Institute of Global Health (Australia),

• Kara Hanson, Professor of Health System Economics, London School of Hygiene & Tropical Medicine (UK)

• Keshav Desiraju, Former Secretary of Health, GoI (India),

• Wim Van Damme, Professor, Institute of Tropical Medicine (Belgium)

Respondents:

• Lucy Gilson, Head, Health Policy & Systems Research, University of Cape Town (South Africa)

• John Porter, Professor, International Health, London School of Hygiene & Tropical Medicine (UK)

Moderator: Prashanth N Srinivas, Assistant Director (Research), IPH Bengaluru (India)

• Experts appreciated the initiative being developed & emphasised that for larger impact, training should

be contextualised to deepen the understanding of health systems and policy space in India. ‘Policy’ in

Health Policy & Systems Research requires focus through training on policy analysis tools, mentorship by

policymakers & implementers creating opportunities for interacting with policy interface. Impact of

research on policy or community was highlighted as a superior output than mere research publications.

• Attributes of fellows to be trained were highlighted. A multidisciplinary pool of fellows could maximize

peer learning and appreciate the fundamental nature of HPSR during their fellowship journey. Candidates

working as clinicians, public health professionals in the policy interface or program implementation could

add value.

• Curriculum should reflect the Indian health systems and policy context with case studies and relevant

examples in Indian settings, while borrowing lessons learned elsewhere. A conscious effort should be

made for a person-centric design, creating opportunity and space for peer learning and HPSR community

building among fellows, experts, and mentors.

• To provide an in-depth experience, it was suggested to include specific HPSR methods customized to

fellows’ needs. Experts commended the exploratory and explanatory lenses of research included in the

curriculum and suggested expanding the evaluative lens further, in line with strengthening critical review

and evaluation of health policies. An understanding of impact evaluation, challenges of attribution,

contribution and relationships between policy and outcomes can orient the researcher in appreciating

demand-driven & participatory research.

• Innovative teaching methods are required in HPSR training to address the challenge of unlearning

traditional linear thought process and adapting systems thinking and complexity.

• Collaboration with governments & various research/ academic institutions was suggested as a strategy

for sustained institutional capacity building.

Panel Discussion Scope & Relevance of HPSR Fellowship

Program in India

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Four parallel sessions with 4-5 experts each were organized for a detailed program review. Sessions were

chaired by Indrani Gupta (quantitative approaches), Sundari Ravindran (qualitative and social Science

approaches), Govert Van Heusden (pedagogy) and Rajeev Sadanandan (policy and practice). A summary of

discussions is presented here:

• Course design, structure, and outputs: Experts highlighted the underlying values of any HPSR training

(ethics, equity, dignity, trust, respect, acknowledgement of tacit knowledge, experiential learning) and

reinforced the need to incorporate them into the fellowship program framework. Focus on policy and

community engagement components was emphasised. The program should integrate a non-linear

approach to framing a research question in the online phase to methodologies, proposal writing in the

face to face phase and then into policy impact and community engagement during the mentorship and

contact sessions. Including systems thinking, public health ethics and policy into the framework of the

program was deemed essential. Though peer-reviewed publications are necessary, diversification of the

course outputs is required.

• Course duration: It was suggested to re-consider the duration of the fellowship to be able to strike an

appropriate balance between fellows’ professional engagements and time spent on fellowship activities.

The breadth of methods proposed to be taught may require more time than is currently planned,

therefore, a specializations track could be considered that would make the timeline more realistic.

• Participant selection: One of the key recommendations in this theme was to aim for a diverse participant

pool to integrate peer-learning capabilities into the program. A mix of disciplines along with few

candidates from non-research experience relevant to strengthening health systems could be considered.

Such a pool would enable rich peer learning. Also, considering the time and effort, it was recommended

that the HPSR research taken up by fellows should be along the line of their work to sustain motivation

and interest throughout the program.

• Mentorship & Contact Sessions: Experts suggested mentorship is key to the program and should be well-

structured and detailed out. Engaging mentors early in the program guides fellows to imbibe concepts

better. Mentorship plays a key role in developing an understanding of the problem, its historical context,

and the complexity. Mentors should be from diverse backgrounds, including civil society organisations

or activists who bring in these perspectives.

• Content: Specific suggestions were made to include secondary data analysis, applied epidemiology,

qualitative methods, reflexivity, evidence synthesis, narrative synthesis, or new ways of framing evidence

that is better adapted to the local policy/implementation context and ability to put forth an argument

effectively. Focus on interdisciplinarity and the ability of fellows to understand the limits of their primary

research discipline and openness to other methods was emphasised.

Break-out Sessions Summary of Discussions

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• Pedagogy: Specific learning/teaching methods such as peer-to-peer engagement and group learning are

essential to emphasise policy engagement and identify appropriate theoretical frameworks. Learning

approaches such as role-plays, case studies, simulations, debates, and discussions right from the online

phase through the research grant phase help to reflexively analyse positionality of the evidence

generated and understand its relevance to diverse stakeholders. It is helpful if policy makers, health

professionals, frontline workers and other stakeholders are brought into the course to co-teach or

interact with the fellows.

• HPSR Core Competencies: Competencies important in HPSR such as reflexivity, complexity, systems

thinking, participatory research approaches and the ability to engage with alternative viewpoints on the

topic of research were highlighted. In line with achieving these, content and learning activities related to

epistemology and self-reflection needs to be developed. Stakeholder analysis, power of coalitions, policy

influencers and ability to analyse complex and evolving relationships help in understanding the policy

interface. There is a need to create a strong foundation of ethics & values underlying HPSR to shape the

research question and approaches.

• Institutions and partnerships: It is necessary to create institutional networks and partnerships to support

the fellowship and co-create content specific to the Indian context. Also, this creates opportunities for

fellows to be engaged in Health Policy & Systems Research in collaboration with health systems

stakeholders.

Break-out Sessions Summary of Discussions

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In the closing remarks, Dr Rahul Reddy, National Co-ordinator, HSTP, expressed that this expert consultation

is a great beginning for all the HPSR stakeholders to connect. HSTP and IPH Bengaluru will herein engage with

stakeholders frequently and explore arrangements with governments, Indian and global public health schools

to collaborate on this initiative. This spirit of collaboration and knowledge exchange is at core of HSTP’s

values. Dr Maharaj Kishan Bhan who has been a pillar of strength for HSTP and continuous be an inspiration.

He believed that enhancing capacities of stakeholder’s is key to transforming Indian health systems. Only

then would home grown solutions to local challenges yield sustainable results. HSTP is developing capacity

building initiatives to suit each of the stakeholder groups. This fellowship is for researchers, one of the key

stakeholders who are to be nurtured, trained in recognizing windows of opportunity, and provided a platform

to advocate for change.

• The plan is to launch the course within this year. Health policy and systems research training program

requires rigour in content development, careful planning, and passionate implementation.

• Inputs received from this expert consultation will be used to revise the program design structure and

curriculum, and an action plan document will be developed.

• A second expert consultation is planned to be held in August 2020 with a group of 6-8 HPSR practitioners

to further fine-tune the structure and design of the program and its curriculum.

• The final design document will be prepared based on the recommendations of this group, which will

further undergo another round of independent review for content and pedagogy.

Next Steps

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1:30 – 1:40 Welcome Address

• Rajeev Sadanandan, CEO, HSTP

• Upendra Bhojani, Director, IPH Bengaluru

1:40 – 2:10 Overview of the Fellowship

• N Devadasan, Technical Advisor, HSTP

• Dorothy Lall, Assistant Director, Education, IPH Bengaluru

• Prashanth NS, Assistant Director, Research, IPH Bengaluru

2:10 – 2:55 HPSR Fellowships Program in India: A panel discussion

Panellists:

• Abdul Ghaffar, Executive Director of WHO Alliance for HPSR (Switzerland),

• Barbara McPake, Director at Nossal Institute of Global Health (Australia),

• Kara Hanson, Health System Economics, LSHTM (UK)

• Keshav Desiraju, Former Secretary of Health – MoHFW, GoI (India)

• Wim Van Damme, Professor, Institute of Tropical Medicine Antwerp (Belgium)

Respondents:

• Lucy Gilson, Head, HPSR, University of Cape Town (South Africa)

• John Porter, Professor, International Health, LSHTM (UK)

Moderator: Prashanth N Srinivas, Assistant Director, Research, IPH Bengaluru

2:55 – 3:00 Break

3:00 – 3:45 Thematic Breakout sessions

Quantitative Approaches

• Indrani Gupta, Health Policy & Research Unit, Institute of Economic Growth (Chair)

• Shanker Prinja, Additional Professor, PGIMER, Chandigarh

• Giridhar Babu, Professor & Head, Life course Epidemiology, PHFI

• Shaktivel Selvaraj, Director, Health Economics, Financing & Policy, PHFI

• Krishna Rao, Associate Professor, Johns Hopkins Bloomberg School of Public Health

• Dorothy Lall, Assistant Director, Education, IPH Bengaluru (Facilitator)

• Vijayashree Yellappa, Senior Specialist, HSTP (Rapporteur)

Qualitative & Social Sciences Research Approaches

• Sundari Ravindran, Shree Chitra Tirunal Institute of Medical Science & Technology (Chair)

• Asha George, Professor Health Systems, University of Western Cape

• Bruno Marchal, Associate Professor & Head, Health Systems, ITM Antwerp

• Sara Van Belle, Associate Professor, ITM Antwerp

• Prashanth NS, Assistant Director, Research, IPH Bengaluru (Facilitator)

• Sukanya Mohanty, Consultant, IPH Bengaluru (Rapporteur)

Pedagogy

• Govert Van Heusden, Academic Coordinator, ITM Antwerp (Chair)

• Carlos Kiyan, e-Learning Coordinator, ITM Antwerp

• Marjan Pirard, MPH Course Coordinator, ITM Antwerp

• Diljith Kannan, Manager EdTech, IIM Bengaluru

• Kranthi Vysyaraju, Program Coordinator IPH Bengaluru (Facilitator)

Agenda Video Conferencing Platform 24 June 2020, 1:30 PM - 4:45 PM (IST)

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• Garima Pathak, Senior Specialist, HSTP (Rapporteur)

Policy & Practice

• Rajeev Sadanandan, CEO, HSTP (Chair)

• Rajani R Ved, Executive Director, National Health Systems Resource Centre

• Upendra Bhojani, Director, IPH Bengaluru

• Rakhal Gaitonde, Professor, Shree Chitra Tirunal Institute of Medical Science & Technology

• Devaki Nambiar, Head - Health Systems & Equity, The George Institute for Global Health

• N Devadasan, Technical Advisor, HSTP (Facilitator)

• Pragati Hebbar, PhD Scholar, IPH Bengaluru (Rapporteur)

3:45 – 3:50 Break

3:50 – 4:35 Closing Plenary: Summary of Breakout Sessions by Rapporteurs

4:35 – 4:45 Closing Remarks Rahul Reddy, National Coordinator, HSTP

Agenda Video Conferencing Platform 24 June 2020, 1:30 PM - 4:45 PM (IST)

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Name Designation Organization/ Affiliation

Abdul Ghaffar Executive Director Alliance for Health Policy and Systems Research, WHO

Amiti Varma Research Associate Institute of Public Health, Bengaluru

Anuska Kalita Research Scientist Harvard School of Public Health

Arun Nair Sr Technical Consultant ACCESS Health International

Asha George Professor School of Public Health, University of Western Cape

Barbara McPake Professor Nossal Institute for Global Health, University of Melbourne

Bruno Marchal Associate Professor Institute of Tropical Medicine, Antwerp

Carlos Kiyan T E-learning Coordinator Institute of Tropical Medicine, Antwerp

Chandra Shekar K Team lead Institute of Public Health, Bengaluru

Devaki Nambiar Program Head George Institute for Global Health

Diljith Kannan Manager EdTech Indian Institute of Management, Bengaluru

Dorothy Lall Faculty Institute of Public Health, Bengaluru

Faustin Chenge Lecturer School of Public Health, University of Lubumbashi

Garima Pathak Senior Specialist Health System Transformation Platform

Giridhar Babu Professor Public Health Foundation of India

Govert van Heusden Academic Coordinator Institute of Tropical Medicine, Antwerp

Haifa Thaha Consultant National Health Systems Resource Centre

Harsha Joshi Consultant National Health Systems Resource Centre

Indrani Gupta Professor Institute of Economic Growth

John Porter Professor London School of Hygiene and Tropical Medicine

Kara Hanson Professor London School of Hygiene and Tropical Medicine

Keshav Desiraju Former Secretary Ministry of Health & Family Welfare, Government of India

Kheya Furtado Assistant Professor Goa Institute of Management

Kranthi V Program Coordinator Institute of Public Health, Bengaluru

Krishna Rao Associate Professor Johns Hopkins University

Krishna Reddy Country Director ACCESS Health International

Latha Chilgod Research Associate Institute of Public Health, Bengaluru

Lucy Gilson Professor University of Cape Town

Mahesh K Research Officer Institute of Public Health, Bengaluru

Marjan Pirard Education Coordinator Institute of Tropical Medicine, Antwerp

Meena Putturaj PhD Student Institute of Public Health, Bengaluru

N Devadasan Technical Adviser Health System Transformation Platform

Neha Dumka Senior consultant National Health Systems Resource Centre

Omkar Palsule-Desai Professor Indian Institute of Management, Indore

Pallavi Gupta Specialist Health System Transformation Platform

Pragati Hebbar PHD Scholar Institute of Public Health, Bengaluru

Pramod Kumar Training Coordinator Institute of Public Health, Bengaluru

Prashanth N S Faculty Institute of Public Health, Bengaluru

Praveen Communication Consultant Institute of Public Health, Bengaluru

Rahul Reddy National Coordinator Health System Transformation Platform

Rajani Ved Executive Director National Health Systems Resource Centre

Rajeev Sadanandan Chief Executive Officer Health Systems Transformation Platform

Participants

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Name Designation Organization/ Affiliation

Sakthivel Selvaraj Director and Professor Public Health Foundation of India

Sanjeev Kumar Research Specialist Health System Transformation Platform

Sara Van Belle Associate Professor Institute of Tropical Medicine, Antwerp

Shankar Prinja Additional Professor PGIMER, Chandigarh

Sridhar Guduthur Chief Financial Officer Health System Transformation Platform

Srinivas Nallala Associate Professor Public Health Foundation of India

Sudha Chandrashekar Consultant Health System Transformation Platform

Sukanya Mohanty Consultant Institute of Public Health, Bengaluru

Sumegha Asthana Chapter Lead Women in Global Health

Sundari Ravindran Principal Visiting Fellow UN University - International Institute for Global Health

Tushar Mokashi Sr Technical Specialist ACCESS Health International

Upasona Ghosh Senior Lecturer Indian Institute of Public Health, Bhubaneshwar

Upendra Bhojani Director Institute of Public Health, Bengaluru

Vaibhav Agavane Consultant Institute of Public Health, Bengaluru

Vijayashree Yellappa Sr Specialist Health System Transformation Platform

Vineet Prakash Risk Mitigation Specialist ACCESS Health International

Wim Van Damme Professor Institute of Tropical Medicine, Antwerp

Yogin V A IT Officer Institute of Public Health, Bengaluru

Participants